is glp 1 tirzepatide or semaglutide GLP-1 vs. GLP-1 + GIP: What's the Difference for your Metabolism? Comparing Semaglutide, Liraglutide, and Tirzepatide:

Circulation 143 , 770779 (2021)

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The apparent contradiction between these potential protective mechanisms and clinical observations of retinopathy worsening likely reflects the complex interplay between rapid metabolic changes and pre-existing vascular damage

Prescription records showing at least 90 consecutive days of metformin at 1,500 mg daily Documented A1C reduction of less than 1.0% during metformin trial, or Documented intolerance to metformin (GI side effects preventing adherence) Criterion 3: BMI and cardiovascular risk documentation (required in 18 states)